Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction:The Q-T interval represents ventricular repolarization of the heart. Prolongation of this interval is called Long QT syndrome (LQTS) and can lead to deadly arrythmias such as Torsades de Pointes. (1) According to the AHA, a Q-T interval is prolonged when it is >450ms in males and >460ms in females. LQTS has different etiologies (not limited to, but including): idiopathic, congenital, electrolyte abnormalities, and drug-induced. (2) However, recreational drugs such as cocaine may often be overlooked by some. A study by Magnano et al. found that cocaine can increase a QTc interval by 23 points (+/- 25) (P
Case Presentation: 42-year-old gentleman with a known history of hypertension not on medications and polysubstance abuse who presented to the ED with complaints of fever, hypertension, sore throat, nausea, bilateral upper and lower extremity joint pains and stiffness and was admitted for sepsis due to influenza. Patient was taking ibuprofen and acetaminophen since the symptoms started. UDS was positive for cocaine, cannabinoids and opioids. EKG on admission was remarkable for sinus tachycardia with qtc of 472. While on the hospital his blood pressure remained persistently elevated with systolic blood pressure in the 200s after nifedipine and hydralazine were administered at the ED. Enalapril injection 1.25 mg q6h PRN was commenced but patient's blood pressure remained elevated with systolic blood pressure in the 200s. Patient blood pressure continued to be elevated regarding treatment; therefore, patient was transferred to the ICU for the management of hypertensive urgency with Cardizem drip. EKG on the second day showed sinus tachycardia with qtc 452. No medication that affects the qtc were given or taken by the patient that are known to cause qtc prolongation except for cocaine.
Conclusion: Cocaine use has been associated with QTc prolongation, which can increase the risk of serious cardiac arrhythmias. Cocaine can interfere with the normal functioning of ion channels in the heart, leading to disruptions in the electrical signals. This disturbance can prolong the QTc interval, potentially causing torsades de pointes or other arrhythmias. Prolongation of the QTc interval can lead to an increased risk of this abnormal heart rhythm, which may result in fainting, seizures, or even sudden cardiac death. Healthcare providers need this information to make informed decisions about prescribing medications, avoiding potentially harmful drug interactions, and ensuring patient safety. It's crucial for healthcare professionals to be aware of these risks when treating individuals who use or have a history of cocaine use, as it can impact decisions regarding medication and overall patient care.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Garcia Cruz, Jian; Pena, Alberto; Perez Rodriguez, Julio; Othon Martinez, Diana; and Kondapavuluru, Roy, "Cocaine Induced QT Prolongation" (2024). Research Symposium. 16.
https://scholarworks.utrgv.edu/somrs/2024/posters/16
Included in
Cocaine Induced QT Prolongation
Introduction:The Q-T interval represents ventricular repolarization of the heart. Prolongation of this interval is called Long QT syndrome (LQTS) and can lead to deadly arrythmias such as Torsades de Pointes. (1) According to the AHA, a Q-T interval is prolonged when it is >450ms in males and >460ms in females. LQTS has different etiologies (not limited to, but including): idiopathic, congenital, electrolyte abnormalities, and drug-induced. (2) However, recreational drugs such as cocaine may often be overlooked by some. A study by Magnano et al. found that cocaine can increase a QTc interval by 23 points (+/- 25) (P
Case Presentation: 42-year-old gentleman with a known history of hypertension not on medications and polysubstance abuse who presented to the ED with complaints of fever, hypertension, sore throat, nausea, bilateral upper and lower extremity joint pains and stiffness and was admitted for sepsis due to influenza. Patient was taking ibuprofen and acetaminophen since the symptoms started. UDS was positive for cocaine, cannabinoids and opioids. EKG on admission was remarkable for sinus tachycardia with qtc of 472. While on the hospital his blood pressure remained persistently elevated with systolic blood pressure in the 200s after nifedipine and hydralazine were administered at the ED. Enalapril injection 1.25 mg q6h PRN was commenced but patient's blood pressure remained elevated with systolic blood pressure in the 200s. Patient blood pressure continued to be elevated regarding treatment; therefore, patient was transferred to the ICU for the management of hypertensive urgency with Cardizem drip. EKG on the second day showed sinus tachycardia with qtc 452. No medication that affects the qtc were given or taken by the patient that are known to cause qtc prolongation except for cocaine.
Conclusion: Cocaine use has been associated with QTc prolongation, which can increase the risk of serious cardiac arrhythmias. Cocaine can interfere with the normal functioning of ion channels in the heart, leading to disruptions in the electrical signals. This disturbance can prolong the QTc interval, potentially causing torsades de pointes or other arrhythmias. Prolongation of the QTc interval can lead to an increased risk of this abnormal heart rhythm, which may result in fainting, seizures, or even sudden cardiac death. Healthcare providers need this information to make informed decisions about prescribing medications, avoiding potentially harmful drug interactions, and ensuring patient safety. It's crucial for healthcare professionals to be aware of these risks when treating individuals who use or have a history of cocaine use, as it can impact decisions regarding medication and overall patient care.